Balloon Valvuloplasty Research Articles

Fetal echocardiography and early neonatal balloon valvuloplasty improved overall survival in prenatally detected aortic stenosis over 25 years of tertiary center experience.

This article aimed to present the factors determining survival and prognosis in fetuses and newborns with critical prenatal aortic stenosis (AS) and to present 26 years of tertiary center experience. Study included 87 fetuses with critical AS requiring surgical intervention during neonatal period. All results were expressed as means ± SD, in numbers and percentages. The statistically significant results were those with p < 0.05. An increase in the number of cases of AS was observed in our center along with a decrease in gestational age of our patients during the first echocardiographic exam. The survival rate of newborns was considerably higher when born in due time (p < 0.05) with body weight > 2500 g (p < 0.05). Balloon valvuloplasty performed in the first days after birth occurred to be an optimal solution in these cases. Fetal echocardiography and special perinatal care with transplacental maternal pharmacotherapy in selected cases and an early neonatal aortic balloon valvuloplasty have shown improvement in survival rate. The most dangerous for the newborn with AS was the first week of postnatal life. It is vital to refer the fetuses with AS to the reference centers which offer the possibility of invasive cardiac intervention on the first day after birth, and it might be an optimal solution.

Extremely severe quadricuspid pulmonary valve stenosis treated by percutaneous balloon valvuloplasty.

Extremely severe quadricuspid pulmonary valve stenosis treated by percutaneous balloon valvuloplasty.

Role of Echocardiography in Balloon Dilatation of Aortic Valve

Aortic valve obstruction accounts for majority of left ventricular outflow tract obstruction. When present in neonatal age group, presentation is more severe and is mostly due to unicomissural aortic valve while at later age, bicuspid aortic valve is the most common cause for aortic stenosis. Echocardiography plays an importance role in the diagnosis and to assess the anatomy for suitability for balloon valvuloplasty. Its role also extends to assess the left ventricle size and function, to diagnose associated lesions and to suggest the suitable plan of management. Echocardiography also plays an important role immediately after balloon dilatation and during follow up to assess adequacy of dilatation and resultant complications. Balloon dilation of bicuspid aortic valves is associated with better outcome and lesser need for reinvention as compared to unicuspid valves.

Abnormalities of External Jugular Veins in Bulldogs with Pulmonary Valve Stenosis

Simple SummaryThis case series is about two French bulldogs and one English bulldog affected by pulmonary valve stenosis that were diagnosed with different abnormalities of the external jugular veins (EJV) before a pulmonary balloon valvuloplasty. The EJV abnormalities encountered were severe hypoplasia of both external jugular veins and right external jugular vein absence, associated with persistent left cranial vena cava. All cases were diagnosed through computed tomography and vascular ultrasound. The aim of this case series is to describe external jugular veins abnormalities that can affect the decision-making process regarding central venous catheterization needed to perform procedures such as pulmonary balloon valvuloplasty or central catheter placement. Based on the results of the present case series, anomalies of the external jugular veins should be considered in French and English bulldogs when the external jugular veins cannot be clinically identified or when echocardiography shows coronary sinus dilation. Vascular ultrasound or computed tomography may help identify jugular venous anomalies and should be considered in the preoperative evaluation of bulldogs that need to undergo interventional procedures requiring transjugular catheterization.Two French bulldogs and one English bulldog affected by pulmonary valve stenosis and referred for pulmonary balloon valvuloplasty were diagnosed with different abnormalities of the external jugular veins. The diagnosis included unilateral absence of the right external jugular vein and bilateral hypoplasia of the external jugular veins, associated with persistent left cranial vena cava. Vascular ultrasound and computed tomography were used for the diagnosis. Jugular vein anomalies can affect decision-making regarding the central venous catheterization needed to perform procedures such as pulmonary balloon valvuloplasty or central catheter placement. Based on the results of the present case series, anomalies of external jugular veins should be considered in French and English bulldogs when the external jugular veins cannot be palpated or when echocardiography shows coronary sinus dilation. Vascular ultrasound or computed tomography may help identify jugular venous anomalies and should be considered in the preoperative evaluation of bulldogs that need to undergo interventional procedures requiring transjugular catheterization.

Computational Analysis of Balloon Catheter Behaviour at Variable Inflation Levels.

Aortic valvuloplasty is a minimally invasive procedure for the dilatation of stenotic aortic valves. Rapid ventricular pacing is an established technique for balloon stabilization during this procedure. However, low cardiac output due to the pacing is one of the inherent risks, which is also associated with several potential complications. This paper proposes a numerical modelling approach to understand the effect of different inflation levels of a valvuloplasty balloon catheter on the positional instability caused by a pulsating blood flow. An unstretched balloon catheter model was crimped into a tri-folded configuration and inflated to several levels. Ten different inflation levels were then tested, and a Fluid-Structure Interaction model was built to solve interactions between the balloon and the blood flow modelled in an idealised aortic arch. Our computational results show that the maximum displacement of the balloon catheter increases with the inflation level, with a small step at around 50% inflation and a sharp increase after reaching 85% inflation. This work represents a substantial progress towards the use of simulations to solve the interactions between a balloon catheter and pulsating blood flow.

Safety and Feasibility of Percutaneous Mitral Balloon Valvuloplasty in Patients With Severe Mitral Stenosis Secondary to Severe Mitral Annular Calcification

Safety and Feasibility of Percutaneous Mitral Balloon Valvuloplasty in Patients With Severe Mitral Stenosis Secondary to Severe Mitral Annular Calcification

Mitral Balloon Valvuloplasty: Risk Factors for Lack of Success, Severe Mitral Regurgitation, and Major Complications

Mitral Balloon Valvuloplasty: Risk Factors for Lack of Success, Severe Mitral Regurgitation, and Major Complications

Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence in Mitral Balloon Valvuloplasty: Immediate Post-Procedure Results

Prior Surgical Mitral Commissurotomy and Echocardiographic Score Influence in Mitral Balloon Valvuloplasty: Immediate Post-Procedure Results

Outcomes of percutaneous balloon pulmonary valvuloplasty in pulmonary valve stenosis in the pediatric population in a single center, Lima - Peru

To evaluate the effectiveness of the procedure and outcomes during follow-up. 80 patients with pulmonary valvular stenosis who underwent percutaneous balloon valvuloplasty between January 2014 and December 2019 are described. Demographic, echocardiographic, and hemodynamic characteristics of the procedure were evaluated. Follow-up included clinical, echocardiographic parameters, pulmonary regurgitation severity, and residual pulmonary gradient at each cutoff point. The age range was 2 years (interquartile range: 10.5 months - 6 years), and the predominant sex was male with 56.2%. The transvalvular pulmonary gradient decreased from 61.7 mmHg +- 21.2 to 17 mmHg (interquartile range: 11-26 mmHg). The immediate success rate was 90%. Follow-up time showed a median of 21 months (interquartile range: 5-47.5 months). All patients at follow-up showed some degree of pulmonary insufficiency at each cutoff point; 17% of the cases at the end of their follow-up were found to have severe insufficiency. Three cases of long-term restenosis were found (3.8%), and 6 (7.5%) were admitted for valvuloplasty surgery or pulmonary valve replacement. The complications reported reached 10% of cases, two patients were admitted to surgery during the procedure for major complications. A significant association was found with severe pulmonary insufficiency at the end of follow-up and ring/balloon ratio. Percutaneous transluminal valvuloplasty with balloon is an effective technique in the treatment of pulmonary valvular stenosis, with reported complications but with good results during follow-up.

Trans-radial buddy balloon technique with a lower profile valvuloplasty balloon in transcatheter aortic valve implantation.

Trans-radial buddy balloon technique with a lower profile valvuloplasty balloon in transcatheter aortic valve implantation.

Balloon aortic valvuloplasty in degenerative aortic stenosis

Balloon valvuloplasty of the aortic valve (BAV) in aortic stenosis has been practiced for over 35 years. The initial enthusiasm caused by the excellent immediate hemodynamic effect of the procedure disappears due to the rapid restenosis of the aortic valve after intervention. The results of modern methods for defi nitive treatment of aortic valve stenosis &amp;ndash; AVR and TAVI are excellent, thanks to which they are fi rmly rooted in treatment guidelines. However, BAV has its indications in symptomatic patients who are not suitable for defi nitive interventions. This publication discusses current indications for BAV, the main stages of the procedure, possible complications, and treatment outcomes.

Bioprosthetic Valve Fracturing: In vitro Testing of Edwards PERIMOUNT Model P 2900.

BackgroundBioprosthetic valve fracturing (BVF) results in low gradients following valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). For the commonly used Edwards PERIMOUNT valve data from bench-testing are lacking to provide technical specifications for successful BVF during ViV-TAVR.MethodsUsing four Perimount 19- and 21-mm valves, in-vitro high-pressure balloon valvuloplasty with the True Dilatation Balloon Valvuloplasty Catheter and Atlas Gold PTA Dilatation Catheter was performed to analyze balloon-oversizing and pressure-thresholds to successfully achieve BVF.ResultsHigh-pressure balloons one millimeter larger than the labeled valve size and pressure rates of 20 atm (for Perimount 19-mm) and > 22 atm (for Perimount 21-mm) were required to achieve BVF. Caliper measurements demonstrated 2.5 mm (Perimount 19-mm) and 1.5 mm (Perimount 21-mm) enlarged inner prosthetic diameters after BVF. The Atlas TM Gold PTA Dilatation Catheter achieved BVF with the Perimount 21-mm, whereas the True TM Dilatation Balloon Valvuloplasty Catheter failed in the Perimount 21-mm either for balloon-rupture or pinhole-defect.ConclusionBoth 19-mm and 21-mm Perimount P 2900 are amendable to BVF, thereby increasing the inner prosthetic diameter. High-pressure balloons 1 mm larger than the labeled valves are essential for this purpose, and the Atlas Gold PTA Dilatation Catheter alone should ensure success in the 21-mm prosthetics.

P151 RIGHT VENTRICULAR MECHANICS IN PATIENTS AFFECTED BY PULMONARY VALVE STENOSIS, BEFORE AND AFTER PERCUTANEOUS PULMONARY VALVULOPLASTY

Abstract Aim of the Study To evaluate the mechanical changes of the right ventricle in patients undergoing balloon pulmonary valvuloplasty using transthstandard transthoracic echocardiography (TTE) and speckle–tracking echocardiography (STE) and to investigate the correlation between haemodynamic and echocardiographic parameters before and after treatment. Materials and Methods 43 pediatric patients (19 males), mean age 3,2±4,9 years with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent TTE and STE with analysis of right ventricle global longitudinal strain (RVGLS) one day before and after the procedure. For each patient were collected invasive parameters during balloon valvulopasty. Results After the procedure, there was an immediate reduction of both peak–to–peak transpulmonary gradient (Dp post) and ratio between the systolic pressure of right and left ventricle (RV/LV ratio) with a drop of 29,3±14,67mmHg and 0,43±0,03, respectively. Post–procedural echocardiography showed peak and mean transvalvar pressure gradient drop (50±32,23 and 31±17,97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, following the intervention it reached 29% with a statistically significant increase (p = 0,007). However, moderate and severe regurgitation remained stable after the procedure. There was a significant improvement of Fractional Area Change (FAC) after the procedure (40,11% vs 44,42%, p = 0,01). TAPSE (p = 0,60) and longitudinal strain (p = 0,31), did not improve significantly after intervention. Finally, pre–procedural invasive RV/LV ratio showed good correlation to echocardiographic transvalvular peak and mean pressure gradient (R = 0,375, p = 0,019 and R = 0,40, p = 0,012, respectively), as well as with FAC (R = 0,31 p = 0,05), TAPSE (R = 0,62 p &amp;lt; 0,001)and RVGLS (R = 0,46 p = 0,01) Conclusions Percutaneous balloon pulmonary valvuloplasty represents an efficient and safe procedure. Right ventricular global systolic function improved following afterload reduction, while longitudinal systolic function did not show improvement immediately after intervention. Finally, invasive preprocedural RV/LV ratio demonstrated better correlation with echocardiographic evaluation of stenosis degree and right ventricular function compared to invasive peak–to–peak pressure gradient. Therefore, RV/LV ratio should be preferred for the assessment of pulmonary valve stenosis.

Incidence, prognosis, and perinatal outcomes of and risk factors for severe twin\u2013twin transfusion syndrome with right ventricular outflow tract obstruction in the recipient twin after fetoscopic laser photocoagulation

BackgroundRight ventricular outflow tract obstruction (RVOTO) is the most frequently encountered congenital heart disease in patients with twin –twin transfusion syndrome (TTTS) and is especially prevalent in the recipient twin. In this retrospective study, we evaluated the incidence, prognosis, postnatal management, and perinatal outcomes of and risk factors for RVOTO in the recipient twin in severe TTTS cases which diagnosed before 26 weeks after fetoscopic laser photocoagulation (FLP) at a single center in Taiwan.MethodsRVOTO was diagnosed using fetal or postnatal echocardiography. The fetal outcomes evaluated were perinatal survival rate, neonatal brain image anomalies rate, gestational age at delivery, and birth weight.ResultsTotal 187 severe TTTS cases were included; 14 (7.49%) had a recipient twin with RVOTO (12 cases of pulmonary stenosis and 2 of pulmonary atresia). Of these 14 cases, 3 (21.4%) demonstrated improvements in outflow obstruction after FLP, and 11 (78.6%) resulted in perinatal survival. Of the 11 survivors, 5 (45.5%) received transcatheter balloon valvuloplasty to alleviate the RVOTO. The perinatal survival rate, gestational age at delivery, neonatal brain image anomaly rate, and birth weights did not significantly differ between the groups in which the recipient twin had versus did not have RVOTO. Generally, the recipient twin had RVOTO received FLP at a younger gestational age (in weeks; 19.3 ± 2.4 vs. 20.7 ± 2.6, p = 0.048) and had a higher percentage of cases at Quintero stage IV (50.0% vs. 12.1%, p < 0.001) than those in which the recipient twin did not have with RVOTO. Using logistic regression, we discovered that FLP at a younger gestational age (p = 0.046, odds ratio = 0.779) and TTTS at Quintero stage IV (p = 0.001, odds ratio = 7.206) were risk factors for the recipient twin developing RVOTO after FLP in severe TTTS cases.ConclusionsThe post-FLP perinatal outcomes of cases of severe TTTS in which the recipient twin had versus did not have RVOTO were comparable in this study, which may have been due to the similar gestational ages at delivery and strong influence of high Quintero stages (stages III and IV).

An early diagnostic case of noonan syndrome with leukocytosis and pulmonary stenosis

Abstract Rationale: Noonan syndrome is a genetic disorder with variable clinical manifestations that affects different systems. Among the multitude of clinical findings, the main characteristics are unique facial traits, low height, and congenital cardiac abnormalities. Recognizing such a syndrome is of great importance because of its involvement of multiple organs. Therefore, a systematic and thorough evaluation according to the guidelines for the assessment and management of Noonan syndrome is needed. Patient concerns: A female infant, 3 months old, presented with a difficult neonatal period (respiratory distress, generalized cyanosis), typical facial dysmorphia, evolutionary height hypotrophy, persistent leukocytosis, factor VII deficit, and severe pulmonary stenosis. Diagnosis: Echocardiography showed severe pulmonary valve stenosis, mild pulmonary regurgitation, a 6.5 mm ostium secundum atrial septal defect, and a persistent ductus arteriosus. Laboratory reports revealed leukocytosis with monocytosis, anemia, and thrombocytopenia, but no infectious source was found. Interventions: In this context, a pulmonary balloon valvuloplasty was performed, with a significant decrease of the transpulmonary gradient. Outcome: The patient was genetically tested, and the reports were positive for Noonan syndrome (mutation in exon 13 of PTPN 11). At 3years of age, she underwent open-heart repair of the atrial septal defect and significant recurrent pulmonary stenosis. The postoperative course was uneventful, and the patient remained asymptomatic at 6months follow-up. Conclusions: The diagnosis was initially suggested by the characteristic unique clinical events associated with cardiac involvement and confirmed later through genetic molecular testing. Prompt treatment of the severe life-threatening pulmonary valve stenosis was important, and the patient underwent additional interventions, after which she remained stable.

Simultaneous Transcatheter Pulmonary Balloon Valvuloplasty and Atrial Septal Defect Closure in Adult Patient

Background: Percutaneous pulmonary balloon valvuloplasty (PBV) has become the first choice of management in patients with valvular pulmonary stenosis, while transcatheter closure in secundum atrial septal defect (ASD) is an alternative therapy besides surgical closure. The combination of PBV and transcatheter ASD closure is an action that is possible to do, but rarely done.Case Illustration: We present a case of 26-year-old woman with severe pulmonary stenosis and secundum ASD. Echocardiographic examination revealed the presence of severe pulmonary stenosis (mean gradient 99.19 mmHg) and defects in the intra atrial septum (with a size of 1.3 cm). Cardiac catheterization revealed right ventricular pressure of 160 mmHg. This patient then successfully corrected with both procedures ASD closure and PBV simultaneously. Discussion: These procedures have high feasibility, good safety, and shows good effectiveness. There were no complications during the procedures, and a satisfying immediate outcome was obtained.Conclusion: Pulmonary stenosis and atrial septal defects are rare forms of congenital heart disease. Transcatheter pulmonary balloon valvuloplasty and atrial septal defect closure performed simultaneously are promising alternatives, apart from surgical correction.

Cirugía de Ross y Ross-Konno en edad pediátrica: ¿es la edad un factor de riesgo?

Introduction and objectivesSevere aortic valve stenosis in pediatric population represents a real surgical challenge. Therapeutic options are highly complex, especially in children under one year of age. Ross procedure is indicated in those cases where surgical repair or balloon valvuloplasty has not been feasible. The aim of the study is compare the postoperative outcomes and in the follow-up of patients under one year with all the patients who underwent Ross / Ross-Konno procedure in our centre. MethodsConsecutive patients operated in our centre with these two procedures for the last ten years were collected. During this period, 11 patients were operated (5 Ross and 6 Ross-Konno) of which 3 corresponded to patients under one year of age. ResultsHospital mortality is 9,1% (1 patient) with a 10-year survival of 90,9%. The reoperations percentage is 72,7%, higher in patients less than 1-year-old (100% vs. 62,5%). Only one patient required an autograft reoperation in the adulthood. The right ventricle outflow tract reoperation rate is 64,6% at 10 years. ConclusionsPostoperative mortality and survival at 10 years of patients operated on during the first year of life does not differ from the rest of older patients, although the rate of reoperations in the follow-up is higher in this subgroup of patients.

Red blood cell abnormalities occur in dogs with congenital ventricular outflow tract obstruction.

To document RBC abnormalities in dogs with congenital ventricular outflow tract obstruction. 62 dogs with pulmonic stenosis (PS) or aortic stenosis (AS) and 20 control dogs were recruited. The proportions of RBCs that were schistocytes, acanthocytes, and keratocytes were assessed. Complete blood cell counts were performed. Tested variables included hemoglobin concentration, hematocrit, and erythrocyte count. Median (interquartile range [IQR]) peak systolic Doppler-derived trans-stenotic pressure gradient (∆P) values were 161 mm Hg (108 to 215 mm Hg) and 134 mm Hg (125 to 165 mm Hg) for dogs with PS and AS, respectively. Hematologic abnormalities were detected in most dogs with AS or PS (54/62 [87%]) versus 8/20 [40%] in control dogs, with schistocytes found in 40 of 62 (65%; median, 0.1% RBCs; IQR, 0% to 0.3%), acanthocytes in 29 of 62 (47%; median, 0.3% RBCs; IQR, 0% to 0.9%), keratocytes in 39 of 62 (63%; median, 0% RBCs; IQR, 0% to 0.2%), and hemolytic anemia in 4 dogs with PS. No significant association was identified between these abnormalities and ∆P. However, 3 of 4 dogs with anemia had a ∆P > 200 mm Hg (range, 242 to 340 mm Hg). The dog with the highest ∆P value also had the most severe anemia and schistocytosis, and both resolved after balloon valvuloplasty. Poikilocytosis is common in dogs with congenital ventricular outflow tract obstruction, with anemia only observed in few dogs with high ∆P values.

The role of three dimensional transesophageal echocardiography novel score in the success of redo percutaneous mitral balloon valvuloplasty

Abstract Funding Acknowledgements Type of funding sources: None. Background Mitral valve morphology is traditionally evaluated according to the images of two-dimensional transthoracic echocardiography and Wilkins score (WS) criteria in the selection of suitable patients for Percutaneous balloon mitral valvuloplasty (PBMV). However, WS does not include mitral commissural morphology, it is known that not only WS but mitral valve commissure morphology is also important in the success of PBMV. It is known that mitral stenosis might develop secondary to the progression of the disease in the follow-up of the patients after first PBMV, and there are a limited knowledge about outcome and success in terms of redo PBMV. Purpose We aimed to determine whether WS in redo PMBV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Methods Our study designed as a retrospective, single center study. Fifty patients who underwent redo PMBV were included in the study. The patients were divided into two groups according to the success of the Redo PMBV procedure which was defined as post-procedural Mitral valve area (MVA) ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation immediately after Redo PMBV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PMBV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. Results In the study group, 36 patients (72%) had successful redo PMBV procedure. WS was 8 (IQR 7 - 9) and novel 3D TEE score was found 4 (IQR 3 - 4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). According to these findings; when both models were compared, the predictive accuracy and performance of the model developed with novel 3D TEE score to predict procedural success was found to be more favorable than the model developed with WS. When the probability of procedural success was calculated according to novel 3D TEE score using univariable logistic regression analysis, the probability of procedural successes was calculated &amp;gt; 90%, especially when novel 3D TEE score was &amp;lt;4. Conclusion The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PMBV, especially in patients who are considered for surgery due to the high WS. Abstract Figure. Definition of novel 3D TEE scoring Abstract Figure. Information about novel 3D TEE scoring

CRT-700.52 Mitral Balloon Valvuloplasty: Risk Factors for Lack of Success, Severe Mitral Regurgitation, and Major Complications

CRT-700.52 Mitral Balloon Valvuloplasty: Risk Factors for Lack of Success, Severe Mitral Regurgitation, and Major Complications